Active NPI
Eduardo Daniel Gonzalez, DDS
- Dentist
- East Peoria, IL
National Provider Identifier
1740806686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019032704
- Practice address
- 220 W Washington St
East Peoria, IL 61611-2477 - Phone
- (309) 839-4673
- NPI assigned
- Jun 16, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019032704 | IL | Primary |
Addresses
Primary practice location
220 W Washington St
East Peoria, IL 61611-2477
Mailing address
125 SW Jefferson Ave # W15C
Peoria, IL 61602-1224
Phone (305) 331-0681
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019032704 | IL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592784000000",
"number": "1740806686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 SW JEFFERSON AVE # W15C",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021224",
"telephone_number": "305-331-0681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 W WASHINGTON ST",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112477",
"telephone_number": "309-839-4673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "EDUARDO",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-16",
"last_updated": "2020-06-22",
"certification_date": "2020-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019032704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.